Research Department, Pharmacyclics, Inc., Sunnyvale, CA;
Blood. 2013 Oct 3;122(14):2412-24. doi: 10.1182/blood-2013-02-482125. Epub 2013 Aug 12.
Ibrutinib (PCI-32765) is a highly potent oral Bruton tyrosine kinase (BTK) inhibitor in clinical development for treating B-cell lymphoproliferative diseases. Patients with chronic lymphocytic leukemia (CLL) often show marked, transient increases of circulating CLL cells following ibrutinib treatments, as seen with other inhibitors of the B-cell receptor (BCR) pathway. In a phase 1 study of ibrutinib, we noted similar effects in patients with mantle cell lymphoma (MCL). Here, we characterize the patterns and phenotypes of cells mobilized among patients with MCL and further investigate the mechanism of this effect. Peripheral blood CD19(+)CD5(+) cells from MCL patients were found to have significant reduction in the expression of CXCR4, CD38, and Ki67 after 7 days of treatment. In addition, plasma chemokines such as CCL22, CCL4, and CXCL13 were reduced 40% to 60% after treatment. Mechanistically, ibrutinib inhibited BCR- and chemokine-mediated adhesion and chemotaxis of MCL cell lines and dose-dependently inhibited BCR, stromal cell, and CXCL12/CXCL13 stimulations of pBTK, pPLCγ2, pERK, or pAKT. Importantly, ibrutinib inhibited migration of MCL cells beneath stromal cells in coculture. We propose that BTK is essential for the homing of MCL cells into lymphoid tissues, and its inhibition results in an egress of malignant cells into peripheral blood. This trial was registered at www.clinicaltrials.gov as #NCT00114738.
依鲁替尼(PCI-32765)是一种在临床开发中用于治疗 B 细胞淋巴增生性疾病的高度有效的口服布鲁顿酪氨酸激酶(BTK)抑制剂。患有慢性淋巴细胞白血病(CLL)的患者在接受依鲁替尼治疗后经常会出现循环 CLL 细胞的明显、短暂增加,这与其他 B 细胞受体(BCR)途径抑制剂一样。在依鲁替尼的一项 1 期研究中,我们在患有套细胞淋巴瘤(MCL)的患者中观察到类似的作用。在这里,我们描述了 MCL 患者中动员的细胞模式和表型,并进一步研究了这种作用的机制。从 MCL 患者的外周血 CD19(+)CD5(+)细胞中发现,在治疗 7 天后,CXCR4、CD38 和 Ki67 的表达显著降低。此外,治疗后血浆趋化因子如 CCL22、CCL4 和 CXCL13 减少了 40%至 60%。从机制上讲,依鲁替尼抑制 BCR 和趋化因子介导的 MCL 细胞系的粘附和趋化作用,并呈剂量依赖性地抑制 BCR、基质细胞和 CXCL12/CXCL13 刺激的 pBTK、pPLCγ2、pERK 或 pAKT。重要的是,依鲁替尼抑制了共培养中基质细胞下 MCL 细胞的迁移。我们提出 BTK 对于 MCL 细胞归巢到淋巴组织是必不可少的,其抑制导致恶性细胞渗出到外周血中。该试验在 www.clinicaltrials.gov 上注册为 #NCT00114738。
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